A review of a paediatric emergency department vaccination programme for patients at risk of allergy/anaphylaxis

Aim: We sought to review the clinical outcomes of patients referred to our emergency department (ED) vaccination service for children with a history of allergy or anaphylaxis or in whom there was a concern of a significant adverse reaction. Methods: This was a prospective observational cohort study set in an urban tertiary Paediatric ED. All attendances for any childhood vaccination for a 5-year period (from January 1, 2006 to December 31, 2010) were included. Our primary outcome measure was any adverse reaction as a result of the vaccine administered. Results: A total of 446 vaccines were administered during the study period in 374 patients. Of these vaccinations, 310 (69.5%) were Measles, Mumps, Rubella (MMR). The majority of patients (348, 93%) were referred from the community. Suspected egg allergy was the reason for the majority of referrals for MMR (261/310 (84.2%)). Only six patients (1.3%) experienced an immediate reaction to a vaccination. All reactions were minor. Conclusion: This is one of the largest studies looking at childhood vaccinations performed in a hospital setting for children who are at risk of allergy, anaphylaxis or hypersensitivity. A significant number of referrals were unwarranted and the majority could have been safely managed in the community.